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Katie Couric's HPV Vaccine Show Triggers Backlash

Katie Couric knows the positive impact celebrity can have on public health decisions. When she underwent a colonoscopy on national TV in 2000, colonoscopy rates jumped by more than 20%.

So why did the former CBS anchor air such a negative segment on human papillomavirus (HPV) vaccine on her show Katie last week? Here is the promo for the show:

In a segment called "The Big Conversation," Couric had a group of guests discuss the "controversy" concerning HPV vaccine. This included a mother whose daughter died of "indeterminate" causes 18 days after receiving the HPV vaccine, and another mother whose daughter had a number of symptoms -- including headache, nausea and vomiting -- after the first two immunizations, plus additional complaints such not being able to get out of bed and having her gallbladder "shut down" after the final immunization. She is now asymptomatic.

The segment also featured Dr. Diane Harper, a medical researcher who was instrumental in developing the vaccine, who recently revised her views on how and when the vaccine should be used.. Dr. Harper argues that the Gardisil "doesn't last long enough to prevent cervical cancer, and HPV infections are something that women continue to get over their lifetime."

She primarily supports the use of Gardasil for limited HPV infection protection: "Gardasil is an option, and if you feel comfortable enough that you want to take it to prevent yourself from getting an infection for a certain length of time that is your right to do."

However, when it comes to cervical cancer prevention, Dr. Harper stated that improved screening is more important. Newer Pap screening with cytology and HPV testing can pick up precancerous lesions and early cancers with "nearly 100% cure rate." She likewise did not think that men and boys needed to be immunized because HPV-caused anal cancer, penile cancer and head and neck cancers are "considered rare diseases by NIH [the National Institutes of Health]." She did say the one exception to this was for "men who have sex with men" who would have a higher incidence of HPV-caused anal cancer.

The only pro-vaccine guest on the show was Dr. Mallika Marshall, a pediatrician at Massachusetts General Hospital. She disputed the claims that 95% of women infected with HPV clear the virus, putting the figure at closer to 80%. What's more, we don't have a good way to figure out who will clear, and who will hold onto the virus long term. She also pointed out that prevention is preferable to later treatment as treatment regimens can be painful and in some cases affect fertility or increase chances of miscarriage.

Backlash against the show began with a blog by Seth Mnookin, science writer and author of the book The Panic Virus. He was approached by the producers of Katie about appearing on the show to discuss the resurgence of diseases like measles and pertussis because parents refuse to immunize their children based on misinformation about the safety of those vaccines. After 7 hours of conversation with producers, Mnookin was told he no longer would be needed on air. It was then that he saw the promo above about the upcoming show and posted his blog.

Other publications quickly followed suit, including Slate, the Los Angeles Times, the Washington Times and others. Slate said that Couric had turned her show over to anti-vaccine alarmists. The Los Angeles Times said that she gave a "false impression of balance when in fact there is little divide about the safety of Gardasil within the scientific community." The Washington Times likened this report to the misinformation about vaccines from Jenny McCarthy, and pointed out that Couric's standing as a respected news anchor may lend some additional "weight" to what is said on her show.

Approximately 79 million persons in the United States are infected with HPV, and approximately 14 million will become newly infected each year.

Every year, about 12,000 women are diagnosed with cervical cancer, and about 4,000 women die from this disease in the U.S.

From June 2006 through March 2013, approximately 56 million doses of HPV4 were distributed in the United States, and from October 2009 through May 2013, a total of 611,000 doses of HPV2 were distributed.

The main efficacy study of the bivalent vaccine was conducted in young women aged 15 through 25 years. Among women who had not been previously exposed to a targeted HPV type, the clinical trials demonstrated 93% vaccine efficacy in preventing cervical precancers due to HPV 16 or 18. In all studies of the bivalent HPV vaccine, more than 99% of females developed an HPV 16 and 18 antibody response 1 month after completing the 3-dose series.

The main efficacy studies of the quadrivalent vaccine were conducted in young women and men (16 through 26 years of age). Among persons not previously exposed to a targeted HPV type, the trials demonstrated nearly 100% vaccine efficacy in preventing cervical precancers, vulvar and vaginal precancers, and genital warts in women caused by the vaccine types, as well as 90% vaccine efficacy in preventing genital warts and 75% vaccine efficacy in preventing anal precancers in men.

Studies suggest that vaccine protection is long-lasting. Current studies (with up to about 6 years of follow-up data) indicate that the vaccines are effective, with no evidence of waning protection. This information will be updated as additional data regarding duration of protection becomes available.

During June 2006–March 2013, the Vaccine Adverse Event Reporting System (VAERS) received a total of 21,194 adverse event reports occurring in females after receipt of HPV4; 92.1% were classified as nonserious.

Among nonserious adverse events, the most commonly reported generalized symptoms were syncope, dizziness, nausea, headache, fever, and urticaria. The most commonly reported local symptoms were injection-site pain, redness, and swelling. Among the 7.9% of HPV4-related VAERS reports classified as serious, headache, nausea, vomiting, fatigue, dizziness, syncope and generalized weakness were the most frequently reported symptoms.
Note that Couric did
mention that she did vaccinate her two daughters. The backlash prompted the Katie show to post another page on Continuing the Conversation.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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